With current advances in technology and knowledge of immune responses at the molecular level, organ and tissuetransplantation is becoming more commonplace. The most frequently transplanted organs are the kidney, liver, andheart. The major problem to be overcome is the immunologic response of the patient to donor tissues. The ability of theimmune system to distinguish self from nonself is crucial to its proper functioning; therefore, in the process of transplantation, the donor/nonself can be rejected. The three forms of rejection are (1) hyperactive or hyperacute(within 48 hr), (2) acute (usually within 3–6 mo), and (3) chronic (occurring months or years after transplant). General postoperative care is similar to that for any other major abdominal or cardiothoracic surgery; however, specialconsiderations necessitate meticulous measures to prevent infection and identify early signs of rejection.

Reactions of family membersConflicts regarding family member(s) ability/willingness to participate, e.g., financial,organ/bone marrow donation, postprocedure supportConcern about benefiting from other person’s deathConcern for family member who must take on new responsibilities as roles shift

May need assistance with ADLs; shopping, transportation, ambulation; managingmedication regimenRefer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES (DEPENDENT ON SPECIFIC ORGAN INVOLVEMENT)

General preoperative screening studies include:

Chest x-ray:

Provides information about status of lungs and heart.

CT/MRI scan:

Reveals status of body systems and organs, including size, shape, and general function of major bloodvessels; organ size for best match with donor organ; and potential sources of postoperative complications. Rulesout presence of cancer, which would contraindicate transplantation.

Total-body bone scan:

Evaluates status of skeletal system to determine presence/absence of bone cancer.

Total isolation is usually restricted to patients with lung transplants or individuals withneutropenia.First-line defense against infection/cross-contamination.Promotes early identification of onset of infection and prompt intervention.Minimizes potential for bacteria to reduce exposure/risk of infection.Mobilizes respiratory secretions and reduces risk of respiratory problems.Meticulous attention to oral mucosa is necessary becauseimmunosuppression/antibiotic therapies increase risk of opportunistic oral/mucosal infections.Identifying organism allows for appropriate treatment.An upward trend from baseline could signal infection;however, a low WBC count may result fromimmnosupressant therapy or from a viral infection.Antibiotics may be used to treat infections, but all must bemonitored for side effects and drug interactions withcyclosporine and other immunosuppressaants required to prevent organ rejection.